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Ramesh Neupane ( BPH , MPH)

Knowledge and protective behaviors of Staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal. Ramesh Neupane ( BPH , MPH). Backgrounds.

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Ramesh Neupane ( BPH , MPH)

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  1. Knowledge and protective behaviors of Staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal RameshNeupane (BPH, MPH)

  2. Backgrounds • Influenza Pandemic is a global outbreak of a influenza virus and it has a capacity of swift transmission from the airdrops (CDC, 2009) • World has faced 4 different influenza Pandemics 1. 1918 Spanish flu - 40 million killed in < 1 year 2. 1957-1958 Asian Flu - 2 million deaths 3. 1968 Hong Kong flu - Approximately one million deaths 4. P.I “A” H1N1, 2009 - 19,000 deaths and 16 million cases • There will be little warning between onset of a pandemic and it’s arrival (WHO, 2010)

  3. Rationales of the study The influenza attack rate among unprotected Health Care Workers might be approximately 60% higher than that of the general population Staff Nurses are the first responders who play key players in any response to influenza pandemic, and will be in the front line of exposure to infection The behaviors and actions of Staff Nurse play a fundamental role in Influenza pandemic’s control and spread Most risk of transmission of Influenza Pandemic to staff Nurses is during the period of care and examination of patients (CDC &WHO, 2010)

  4. Influenza Burden in Nepal Nepal has faced one potential influenza pandemic outbreak in January 2009 (Avian Flu H5N1): No human death cases Outbreak of Influenza pandemic A H1N1 was in October, 2009 with 172 cases and 4 deaths Very few study on influenza Pandemic in Nepal and had no study on Knowledge and protective behavior

  5. Research questions What is the level of knowledge of staff Nurses towards Influenza Pandemic at some health care settings of Kathmandu and Chitwan district, Nepal? What are the factors influencing the Knowledge and protective behaviors of staff Nurse towards Influenza Pandemic

  6. Objectives General Objective • To assess the knowledge and Protective behaviors of staff Nurses towards Pandemic influenza at some Health care facilities of Kathmandu and Chitwan district, Nepal Specific Objective • To compare the Knowledge and protective behavior of staff nurses towards pandemic Influenza • To identify the factors influencing Knowledge and protective behavior of staff nurses towards Pandemic Influenza

  7. Conceptual Framework • Dependent variables • Independent variables • Protective behavior • Hand washing • Immunization • Personal protective Equip • Masks • Cloth • Surgical • N-95 • Gloves • Gown • Goggles • Face shield • General Characteristics • Age • Working area • Working durations • Types of hospital • Hospitals guideline • contact with PI patients • Knowledge • Sign and symptoms • Mode of transmission • Prevention 

  8. Research Methodology Hos. 1 Kathmandu Hos. 2 Study population Systematic RS Simple RS Purposive Hos. 3 Chitwan Hos. 4 • Study design : Quantitative cross-sectional, comparative study • Study population : Staff Nurse • Study area :Hospitals of Kathmandu and Chitwan District • Study period : Feb to March of 2012 • Sampling technique

  9. Research Tools A structured questionnaire Part 1: General Characteristics 7 questions Part 2: Knowledge towards IP “A”H1N1 46 questions Part 3: Protective Behavior towards IP “A”H1N1 44 questions • References: (SeldaAslan et al, 25 Aug, 2010and WHO)

  10. Sample calculation (Cochran) Z2 P (1 ─ P) n = (e) 2 (1.96)2 0.5 (1 ─ 0.05) n = = 384 (0.05) 2 Where, n = Sample size. p = Estimated proportion of the population likely to have knowledge about PI is 50% e = Desired level of precision. z= Value from normal distribution associated with 95% confidence interval of 1.96 Taking 10% as the withdraw cases the total sample size 384+38.4(10%) = 423

  11. Data Collection Process 1. One data collector was hired for each hospital and • 2.Data collector was orientated with objective and methodology before collect the data Sample size (424) Kathmandu (212) Chitwan (212 ) Teaching Hospital 106 Bharatpur Hospital 106 Teku Hospital 54 Om Hospital 52 Chitwan Medical College 106

  12. Data analysis process Descriptive statistics Frequency and percentage were used for describing general characteristics, knowledge and protective behavior towards Influenza pandemic by using tables and bar diagrams Analytical statistics • Student’s T-test was used to find the significant difference in the means of knowledge and protective behavior • Chi square test was used to calculate the association between dependent variables (protective behavior) and independent variables (general characteristics and level of knowledge) • Spearman’s correlation test was used to find the correlation between knowledge and protective behavior.

  13. Validity and Reliability • Questionnaires were verified by highly qualified adviser and 3 concerned public health expertise of Kathmandu and Chitwan • The reliability test was done by pre-test among 30 Staff nurses • Cronbach alpha coefficient was used for testing reliability of measurement tool (only Knowledge related questionnaire) which gave the result of 0.781

  14. Ethical consideration The study was reviewed and approved by Nepal Health Research Council (NHRC), Ministry of Health and Population (MOHP), Nepal The written and verbal consent was taken from hospitals as well as respondents

  15. Results

  16. Results

  17. Results Relation between working districts and Level of Knowledge of PI Relation between working districts and Protective Behaviorof PI Relation between working districts and protective Behavior

  18. Results Finding which achieved objective 1: (One sample T test) • Compare the knowledge and protective behavior according to district

  19. Results Association between the formal Infection control training with knowledge and protective behavior

  20. Results Association between the people contacted with PI patients and knowledge and protective behavior • *Only for those participants who ever contacted with Influenza pandemic patients

  21. Results Correlation between knowledge and protective score of Kathmandu and Chitwan district

  22. Bivariate analysis: Objective 2: To identify the factor influencing Knowledge and Protective Behavior

  23. Discussions and Conclusion • Formal infectious control training was found statistically significant for level of Knowledge but insignificant for protective behavior • This study revealed that 16.51% of participants Felt protected from Transmission of PI, while examining Pandemic influenza patients • This study found that nurses had high level of knowledge but does not had good protective behavior

  24. Recommendations – Policy level Nepal government ministry of health and population should provide the necessary equipments to nurses to prevent from the transmission of Influenza pandemic Need to enhance the level of knowledge of nurses especially focusing on uses of Personal protective equipments Healthcare Workers should be offered the vaccine against the pandemic influenza strain when the vaccine becomes available

  25. Some pictures

  26. Some pictures

  27. Thank you

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